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DOI: 10.1055/s-0038-1639447
The Development of AI in Medicine and the Research Environment of the SPHINX Project at the Start of the 1980s
Summary
Objectives
To review the history of AI in Medicine in the 1980’s, placing the SPHINX system in the context of other research in this field.
Methods
Summarize the main systems for AI in medicine devel- oped in the 1970-1980 decade and their relationship to the de- velopment of clinical decision-making and consultation systems.
Results
The approaches taken by AI in medicine research groups is compared and contrasted to those of others using statistical and logical methods for representing clinical inferences, and the different AI approaches are summarized, and related to the archi- tecture and systems implementation of SPHINX.
Conclusion
The SPHINX system combined a number of advanced representational and inference choices from AI in designing a de- cision-support system for clinical consultation in the 1980s. The context within which the system was developed is outlined and related to the historical evolution of AI in medicine during that decade.
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Keywords
Artificial Intelligence(AI) in medicine - history - SPHINX Project - frame representation - production-rules
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References
- 1 Ledley RS, Lusted L. Reasoning foundations of médical diagnosis. Science 1959; 130: 9-21.
- 2 Warner HR, Toronto HF, Veasy LG. A mathematical approach to médical diagnosises : Applications to congénital heart disease. JAMA 1961; 177: 177-83.
- 3 Gorry GA, Barnett GO. Experience with a model of sequential diagnosis. Comput Biomed Res 1968; 490-507.
- 4 De Dombal FT, Leaper DJ, Staniland JP, McCann AP, Horrocks JC. Computer Aided Diagnosis of Acute Abdominal Pain. BMJ 1972; 02: 9-13.
- 5 Deutsch T, Carson E, Ludwig E. Dealing with Medical Knowledge: Computers in Clinical Decision Making. NewYork: Plenum press; 1994
- 6 Davis R, King JJ. The Origin of Rule-Based Systems in AI. In: Buchanan BG, Shortliffe EH. editors. Rule-Based Expert Systems. The Mycin experiments of the Stanford Heuristic Programming Project. Addisson-Wesley; 1984: 20-52.
- 7 Newell A. Production systems: Models of control structures. In: Chase WG. editor. Visual Information Processing. New York: Academic Press; 1973: 463-526.
- 8 Shortliffe EH. Computer-Based Medcial Consultations: MYCIN. NewYork: Elsevier; 1976
- 9 Institute of Medicine. To Err is Human: Building A Safer Health System. Consensus report. NewYork: National Academy Press; Nov. 1999
- 10 Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Consensus report. New York: National Academy Press; March 2001
- 11 Ganascia JG. L’âme-machine. Paris: Seuil; 1990
- 12 Newell A, Simon H. GPS a Program that Simulates Human Thought. In: Feigenbaum EA, Feldman J. editors. Computers and thought. New York: McGraw-Hill; 1963
- 13 Winograd T. Frame representations and the procedure/declarative controversy. In: Bobrow DG, Collins A. Representation and the Understanding, Studies in Cognitive Science. New York: Academic Press; 1975: 185-210.
- 14 Minsky M. A Framework for Representing Knowledge. In: Winston PH. editor. The psychology of Computer Vision. New York: McGraw-Hill; 1975: 211-77.
- 15 Pauker SG, Szolovits P. Analyzing and simulating taking the history of the oresent illness: context formation. In: Schneider W, Sgvall-Hein AL. editors. IFIP Working Conference on Computational Linguistics in Medicine. Amsterdam: North Holland; 1977: 109-18.
- 16 Fagan L, Shortliffe EH, Buchanan BG. Computer- Based Medical Decision Making: from MYCIN to VM. Stanford Heuristic Programme Project, HPP79-18. 1979
- 17 Clancey WJ. The Epistemology of a Rule-based Expert System: A Framework for Explanation. Artificial Intelligence 1983; 20: 215-51.
- 18 Patil RS. Causal Representation of Patient Illness for Electrolyte anda Acid-Base Diagnosis. PhD Thesis. MIT Laboratory for Computer Science. Cambridge Mass; 1981
- 19 Kulikowski CA, Weiss SM. Representation of Expert Knowledge for consultation: the CASNET and expert Projects. In: Szolovits P. Artificial Intelligence in Medicine. Westview; Colorado: 1982: 21-55.
- 20 Pople Jr HE. Heuristic Methods for imposing Structure on Ill Structured Problems: The Structuring of Medical Diagnostics. In: Szolovits P. Artificial Intelligence in Medicine. Westview; Colorado: 1982: 119-90.
- 21 Miller PL. Medical Plan-Analysis by Computer. In: Van Bemmel JJ, Ball MJ, Wigertz O. editors. MEDINFO 83. Amsterdam: North Holland; 1982
- 22 Rector AL. Defaults, exceptions and ambiguity in a medical knowledge representation system. Med Inform 1986; Oct-Dec; 11 (04) 295-306.
- 23 Zarkadakis G, Carson ER, Cramp DG, Finkelstein L. ANABEL: intelligent blood-gas analysis in the intensive care unit. Int J Clin Monit Comput 1989; 06 (03) 167-71.
- 24 Fox J, Glowinski A, Gordon C, Hajnal S, O’Neil M. Logic engineering for knowledge engineering: design and implementation of the Oxford System of Medicine. Artif Intell Med 1990; 02: 323-39.
- 25 Timpka T, Hjerppe R, Strömberg D, Möller I, Bjurulf P, Gill H. et al. Decision support for General Practitioners by integrating paradigms: Hypertext, Knowledge based and Electronic library. In: Salamon R, Blum B, Jörgensen M. editors. MEDINFO 86. Amsterdam: North-Holland; 1986: 96-100.
- 26 Adlassnig KP, Kolarz G. Representation and semiautomatic acquisition of medical knowledge in CADIAG-1 and CADIAG-2. Comput Biomed Res 1986; 19 (01) 63-79.
- 27 Lesmo L, Marzuoli M, Molino G, Torasso P. An expert system for the evaluation of liver functional assessment. J Med Syst 1984; 08 1-2 87-101.
- 28 Quaglini S, Stefanelli M, Barosi G, Berzuini A. ANEMIA: an expert consultation system. Comput Biomed Res 1986; 19 (01) 13-27.
- 29 Weiss S, Kulikowski CA. EXPERT: a system for developing consultation models. Proc Sixth Int Conf on Artif Intelligence; Tokyo: 1979
- 30 Gascuel O. SAM: un système expert dans le domaine médical. [An expert system in the medical domain] PhD Thesis. Université de Paris VI: 1981
- 31 Fontaine P, Beuscart R, Lecoq P, Vambergue A. DIABAID : Un système expert d’aide à l’adaptation de l’insulinothérapie. [An expert system helping for adaptation of insulinotherapy]. Innovation et Technologie en biologie et médecine 1997; 18 (06) 421-31.
- 32 Sanchez E, Soula G. Possibilistic analysis of fuzzy modelling in medecine. In: Vantenkiste Young. editors. Modeling and data analysis in biotechnology and medical engineering. Amsterdam: North Holland; 1982: 127-38.
- 33 Gouvernet J, Caraboeuf M, Ayme S. GENDIAG: a computer-assisted facility in medical genetics based on belief functions. Methods Inf Med 1985; 24 (04) 177-80.
- 34 Soula G, Vialettes B, San JJLMarco. PROTIS: a fuzzy deduction rule system: application to the treatment of diabetes. Van Bemmel JH, Ball MJ, Wigertz O. editors. Medinfo 1983. Amsterdam: North Holland; 1983: 533-6.
- 35 Lanzola G, Quaglini S, Stefanelli M. Knowledge- acquisition tools for medcial knowledge-based systems. Methods Inf Med 1995; 34 1-2 25-39.
- 36 Fieschi M. Intelligence Artificielle en Médecine : des systèmes experts. Paris: Masson; 1984
- 37 Fieschi M. Artificial Intelligence in Medicine-Expert systems. Translated by Cramp D. London: Chapman and Hall; 1990
- 38 Fieschi M, Joubert M, Fieschi D, Botti G, Roux M. A program for expert diagnosis and therapeutic decision. Med Inform (Lond) 1983; 08 (02) 127-35.
- 39 Rescher N. ManyValued Logic. NewYork: McGraw- Hill; 1969
- 40 Shafer G. A Mathematical Theory of Evidence. Princeton University Press; 1976
- 41 Soula G. Aide à la décision en logique floue. Application en médecine. Thèse Doctorat de Biologie Humaine. [Decision support in fuzzy logic. Doctoral thesis] Marseille. 1981
- 42 Joubert M, Fieschi M, Fieschi D, Roux M. Knowledge representation and utilisation in a man- machine dialogue with a medical decision aid system. Methods Inf Med 1982; 21 (02) 59-64.
- 43 Fieschi D. Contribution au système expert SPHINX: Application à l’enseignement médical. Thèse de 3ème cycle. [Contribtion to the SPHINX expert system: Application to medical teaching]. Université Paris 6; 1984
- 44 Michel C, Botti G, Fieschi M, Joubert M, San JLMarco, Casanova P. Validation of a Knowledge Base Intended for General Practitioners to Assist Treatmlent of Diabetes: A blind Study. In: Salamon R, Blim BI, Jorgensen M. editors. Proc. Medinfo 86. Amsterdam: North Holland; 1986: 122-6.
- 45 Fieschi M, Botti G, Michel C, Joubert M, Proudhon H, Fieschi D. Etude de mise à disposition des praticiens généralistes d’un système expert d’aide à la thérapeutique du diabète (étude de faisabilité). Rapport de fin de contrat ADI n° 84-747 Faculté de Médecine de Marseille..
- 46 Komaroff Al, Black WL, Flatley M, Knopp RH, Reiffen B, Sherman H. Protocols for physicians assistants. Management of Diabetes and Hypertension. N Engl J Med 1974; 290 (06) 307-12.
- 47 Abendroth TW, Greenes RA. Computer presentation of clinical algorithms. MD Comput 1989; 06 (05) 295-9.
- 48 Ciccarese P, Caffi E, Quaglini S, Stefanelli M. Architectures and Tools for innovative Health Information Systems : The Guide Projetc. Int J Med Inform 2005; 74 7-8 553-62.
- 49 Pryor TA, Gardner RM, Clayton PD, Warner HR. The HELP System. J Med Syst 1983; 07: 87-102.
- 50 McDonald CJ. Protocol-based computers reminders, the quality of care and the non-perfectability of man. N Engl J Med 1976; 295: 1351-5.
- 51 Hripcsak G, Wigertz OB, Kahn MG, Clayton PD, Pryor TA. ASTM E31.15 on health knowledge representation : the Arden Syntax. Stud Health Technol Inform 1993; 06: 105-12.
Correspondence to
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References
- 1 Ledley RS, Lusted L. Reasoning foundations of médical diagnosis. Science 1959; 130: 9-21.
- 2 Warner HR, Toronto HF, Veasy LG. A mathematical approach to médical diagnosises : Applications to congénital heart disease. JAMA 1961; 177: 177-83.
- 3 Gorry GA, Barnett GO. Experience with a model of sequential diagnosis. Comput Biomed Res 1968; 490-507.
- 4 De Dombal FT, Leaper DJ, Staniland JP, McCann AP, Horrocks JC. Computer Aided Diagnosis of Acute Abdominal Pain. BMJ 1972; 02: 9-13.
- 5 Deutsch T, Carson E, Ludwig E. Dealing with Medical Knowledge: Computers in Clinical Decision Making. NewYork: Plenum press; 1994
- 6 Davis R, King JJ. The Origin of Rule-Based Systems in AI. In: Buchanan BG, Shortliffe EH. editors. Rule-Based Expert Systems. The Mycin experiments of the Stanford Heuristic Programming Project. Addisson-Wesley; 1984: 20-52.
- 7 Newell A. Production systems: Models of control structures. In: Chase WG. editor. Visual Information Processing. New York: Academic Press; 1973: 463-526.
- 8 Shortliffe EH. Computer-Based Medcial Consultations: MYCIN. NewYork: Elsevier; 1976
- 9 Institute of Medicine. To Err is Human: Building A Safer Health System. Consensus report. NewYork: National Academy Press; Nov. 1999
- 10 Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Consensus report. New York: National Academy Press; March 2001
- 11 Ganascia JG. L’âme-machine. Paris: Seuil; 1990
- 12 Newell A, Simon H. GPS a Program that Simulates Human Thought. In: Feigenbaum EA, Feldman J. editors. Computers and thought. New York: McGraw-Hill; 1963
- 13 Winograd T. Frame representations and the procedure/declarative controversy. In: Bobrow DG, Collins A. Representation and the Understanding, Studies in Cognitive Science. New York: Academic Press; 1975: 185-210.
- 14 Minsky M. A Framework for Representing Knowledge. In: Winston PH. editor. The psychology of Computer Vision. New York: McGraw-Hill; 1975: 211-77.
- 15 Pauker SG, Szolovits P. Analyzing and simulating taking the history of the oresent illness: context formation. In: Schneider W, Sgvall-Hein AL. editors. IFIP Working Conference on Computational Linguistics in Medicine. Amsterdam: North Holland; 1977: 109-18.
- 16 Fagan L, Shortliffe EH, Buchanan BG. Computer- Based Medical Decision Making: from MYCIN to VM. Stanford Heuristic Programme Project, HPP79-18. 1979
- 17 Clancey WJ. The Epistemology of a Rule-based Expert System: A Framework for Explanation. Artificial Intelligence 1983; 20: 215-51.
- 18 Patil RS. Causal Representation of Patient Illness for Electrolyte anda Acid-Base Diagnosis. PhD Thesis. MIT Laboratory for Computer Science. Cambridge Mass; 1981
- 19 Kulikowski CA, Weiss SM. Representation of Expert Knowledge for consultation: the CASNET and expert Projects. In: Szolovits P. Artificial Intelligence in Medicine. Westview; Colorado: 1982: 21-55.
- 20 Pople Jr HE. Heuristic Methods for imposing Structure on Ill Structured Problems: The Structuring of Medical Diagnostics. In: Szolovits P. Artificial Intelligence in Medicine. Westview; Colorado: 1982: 119-90.
- 21 Miller PL. Medical Plan-Analysis by Computer. In: Van Bemmel JJ, Ball MJ, Wigertz O. editors. MEDINFO 83. Amsterdam: North Holland; 1982
- 22 Rector AL. Defaults, exceptions and ambiguity in a medical knowledge representation system. Med Inform 1986; Oct-Dec; 11 (04) 295-306.
- 23 Zarkadakis G, Carson ER, Cramp DG, Finkelstein L. ANABEL: intelligent blood-gas analysis in the intensive care unit. Int J Clin Monit Comput 1989; 06 (03) 167-71.
- 24 Fox J, Glowinski A, Gordon C, Hajnal S, O’Neil M. Logic engineering for knowledge engineering: design and implementation of the Oxford System of Medicine. Artif Intell Med 1990; 02: 323-39.
- 25 Timpka T, Hjerppe R, Strömberg D, Möller I, Bjurulf P, Gill H. et al. Decision support for General Practitioners by integrating paradigms: Hypertext, Knowledge based and Electronic library. In: Salamon R, Blum B, Jörgensen M. editors. MEDINFO 86. Amsterdam: North-Holland; 1986: 96-100.
- 26 Adlassnig KP, Kolarz G. Representation and semiautomatic acquisition of medical knowledge in CADIAG-1 and CADIAG-2. Comput Biomed Res 1986; 19 (01) 63-79.
- 27 Lesmo L, Marzuoli M, Molino G, Torasso P. An expert system for the evaluation of liver functional assessment. J Med Syst 1984; 08 1-2 87-101.
- 28 Quaglini S, Stefanelli M, Barosi G, Berzuini A. ANEMIA: an expert consultation system. Comput Biomed Res 1986; 19 (01) 13-27.
- 29 Weiss S, Kulikowski CA. EXPERT: a system for developing consultation models. Proc Sixth Int Conf on Artif Intelligence; Tokyo: 1979
- 30 Gascuel O. SAM: un système expert dans le domaine médical. [An expert system in the medical domain] PhD Thesis. Université de Paris VI: 1981
- 31 Fontaine P, Beuscart R, Lecoq P, Vambergue A. DIABAID : Un système expert d’aide à l’adaptation de l’insulinothérapie. [An expert system helping for adaptation of insulinotherapy]. Innovation et Technologie en biologie et médecine 1997; 18 (06) 421-31.
- 32 Sanchez E, Soula G. Possibilistic analysis of fuzzy modelling in medecine. In: Vantenkiste Young. editors. Modeling and data analysis in biotechnology and medical engineering. Amsterdam: North Holland; 1982: 127-38.
- 33 Gouvernet J, Caraboeuf M, Ayme S. GENDIAG: a computer-assisted facility in medical genetics based on belief functions. Methods Inf Med 1985; 24 (04) 177-80.
- 34 Soula G, Vialettes B, San JJLMarco. PROTIS: a fuzzy deduction rule system: application to the treatment of diabetes. Van Bemmel JH, Ball MJ, Wigertz O. editors. Medinfo 1983. Amsterdam: North Holland; 1983: 533-6.
- 35 Lanzola G, Quaglini S, Stefanelli M. Knowledge- acquisition tools for medcial knowledge-based systems. Methods Inf Med 1995; 34 1-2 25-39.
- 36 Fieschi M. Intelligence Artificielle en Médecine : des systèmes experts. Paris: Masson; 1984
- 37 Fieschi M. Artificial Intelligence in Medicine-Expert systems. Translated by Cramp D. London: Chapman and Hall; 1990
- 38 Fieschi M, Joubert M, Fieschi D, Botti G, Roux M. A program for expert diagnosis and therapeutic decision. Med Inform (Lond) 1983; 08 (02) 127-35.
- 39 Rescher N. ManyValued Logic. NewYork: McGraw- Hill; 1969
- 40 Shafer G. A Mathematical Theory of Evidence. Princeton University Press; 1976
- 41 Soula G. Aide à la décision en logique floue. Application en médecine. Thèse Doctorat de Biologie Humaine. [Decision support in fuzzy logic. Doctoral thesis] Marseille. 1981
- 42 Joubert M, Fieschi M, Fieschi D, Roux M. Knowledge representation and utilisation in a man- machine dialogue with a medical decision aid system. Methods Inf Med 1982; 21 (02) 59-64.
- 43 Fieschi D. Contribution au système expert SPHINX: Application à l’enseignement médical. Thèse de 3ème cycle. [Contribtion to the SPHINX expert system: Application to medical teaching]. Université Paris 6; 1984
- 44 Michel C, Botti G, Fieschi M, Joubert M, San JLMarco, Casanova P. Validation of a Knowledge Base Intended for General Practitioners to Assist Treatmlent of Diabetes: A blind Study. In: Salamon R, Blim BI, Jorgensen M. editors. Proc. Medinfo 86. Amsterdam: North Holland; 1986: 122-6.
- 45 Fieschi M, Botti G, Michel C, Joubert M, Proudhon H, Fieschi D. Etude de mise à disposition des praticiens généralistes d’un système expert d’aide à la thérapeutique du diabète (étude de faisabilité). Rapport de fin de contrat ADI n° 84-747 Faculté de Médecine de Marseille..
- 46 Komaroff Al, Black WL, Flatley M, Knopp RH, Reiffen B, Sherman H. Protocols for physicians assistants. Management of Diabetes and Hypertension. N Engl J Med 1974; 290 (06) 307-12.
- 47 Abendroth TW, Greenes RA. Computer presentation of clinical algorithms. MD Comput 1989; 06 (05) 295-9.
- 48 Ciccarese P, Caffi E, Quaglini S, Stefanelli M. Architectures and Tools for innovative Health Information Systems : The Guide Projetc. Int J Med Inform 2005; 74 7-8 553-62.
- 49 Pryor TA, Gardner RM, Clayton PD, Warner HR. The HELP System. J Med Syst 1983; 07: 87-102.
- 50 McDonald CJ. Protocol-based computers reminders, the quality of care and the non-perfectability of man. N Engl J Med 1976; 295: 1351-5.
- 51 Hripcsak G, Wigertz OB, Kahn MG, Clayton PD, Pryor TA. ASTM E31.15 on health knowledge representation : the Arden Syntax. Stud Health Technol Inform 1993; 06: 105-12.